A METHOD OF DRESSING EYES.

A METHOD OF DEESSING EYES

AFTER CATARACT EXTRACTION AND OTHER OPHTHALMIC OPERATIONS'.
REQUIRING REST BY EXCLUSION OF LIGHT.

Read before the American Ophthalmological Society, 1869,

By C. R. AGNEW, M. D.

The accompanying woodcut shows the dressing. It con¬
sists, first, of two strips of isinglass plaster, about two and

one-half inches long by a quarter of an inch wide, applied
over the closed eyelids to keep them shut ; next of a strip of
soft, thin linen or cotton cloth, in the form of a parallelogram,

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large enough to extend laterally beyond the temporal edges
of the orbital rims, upwards to clear the superciliary ridges,
and downwards to a horizontal line drawn through the cheek¬
bones. Next a piece of black silk sufficiently large to overlap
all but the upper edge of the cloth ; next of some strips of
isinglass plaster long enough and broad enough to attach them¬
selves partly to the silk and partly to the contiguous skin, so
as to hold the dressing in place. If the silk be so thin as to
be translucent it should be made of two folds, otherwise one
fold will suffice. A notch may be made in the centre of the
lower edge of cloth and silk, so as to permit a close coapta¬
tion between the dressings and the skin in the angles formed
by the intersection of the wings of the nostrils with the surface
at the base of the upper lip.

It is claimed that this dressing, when carefully applied, is
.sufficiently permeable to permit the proper escape of heat and
moisture, and is yet so opaque as to shut out light, and there¬
fore to produce natural rest for the eyes, while it is free
from weight, and incapable of making any other pressure
than that which the natural coaptation of the eyelids and eye¬
ball makes.

It is a clinical desideratum to be able to treat a case of
ophthalmic surgery in a well lighted room, without admitting
light to the wounded organ. Such a dressing makes it easy
to surround old and feeble subjects witli an atmosphere chem¬
ically fitted by direct light for purposes of respiration, and
thus to quicken the vital forces and lessen the dangers which
spring from delayed or perverted reparative processes. It
favors regular and easy care of the patient, and the per¬
formance of such offices as may pertain to his comfort or
safety. It permits, at proper times, such entertainment
as may tend to give pleasant occupation to the mind and
banish the apprehension and dread which always exist, to a
greater or less degree, in the case of those who are served in
the dark by groping or stumbling attendants.

It is claimed, moreover, that this dressing does away with
the dangers arising from the use of pressure bandages, dangers
much greater than some are now prepared to admit — but
dangers proved to exist by the great variety of the bandages,

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and the attempt made to give formulas for the measurement
of the pressure made by a given bandage.

We believe that there would be fewer eyes lost by suppu¬
ration, after extraction, for example, if pressure bandages
were entirely discarded from the surgical armamentarium,
and eyes allowed to be shut and at rest unopened for a few
days after severe operations.

It remains to be proved that pressure aids the union of
wounds in the eyeball. We believe that the natural dressing
of a wounded eye is the closed eyelids, and the only other
local condition needed is the rest afforded by the exclusion
of light by closure of eyes and repose of the facial muscles.
Pressure enough from bandages to secure such desiderata is
scarcely attainable, or, if obtained, becomes so soon intolerable
as to provoke the surgeon to a speedy readjustment of his
bandage — a readjustment often made necessary for the relief
of symptoms which are found, on a candid examination, to
have originated in the effects produced by accidental displace¬
ment of the bandage which, perhaps, twelve hours previously
had been fastidiously applied.

This method may also be used after the abstraction of blood
by Heurteloup’s leech, giving the local rest afforded by dark¬
ness, and, when desirable, associated with gentle bodily exer¬
cise to keep up the play of the circulation, and thus help to
discuss a choroidal or other ophthalmic congestion.

It is our common practice to apply this dressing immediately
after an extraction, and not to remove it until the expiration
of five days, when it can be easily detached by washing, and
reapplied, if need be. A very little experience will enable a
surgeon to post himself as to the progress of a case after ex¬
traction bv the subjective symptoms, with the additional testi¬
mony obtained by gently passing the finger over the silk
dressings to determine the question as to whether swelling
of the lids exists.

Let a patient be placed after an extraction operation amid
such circumstances as will tend to increase gently and healthful¬
ly the activity of the nutritive forces; protect him against the
meddlesome officiousness of a peeping pathologist, and less will
be known of the small beginnings of morbid changes in wounds

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and fewer eyes lost. The vis medicatrix naturae can no¬
where play a more satisfactory part than in the healing of
eye-wounds. To this end there must be a good supply of
nourishing food, excluding alcohol, excepting in cases where
you wish to retard the tissue-wasting of old age. There
should be rest of the wounded and fellow eye insured by clos¬
ure of eyelids and exclusion of light. There should be fresh
air, influenced by the presence of sunlight, for the patient to
breathe. There should be the cheerful presence of discreet
attendants, not of persons given to restless meddling.

The dressings after an extraction or iridectomy should be
allowed to remain upon the eyes until the afternoon of the fourth
or fifth day, and the temptation to open the eyes met by the
recollection of the fact that there is a struggle in every wound
between the reparative and destructive forces, and that rest
by exclusion of light and air aids the former and antagonizes
the latter.